Wufoo

Tannenbaum-Sternberger Foundation

Application For Grant

Information About The Applicant
Name of the Organization
Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Chief Executive Officer
Contact Person For Application
Address (if different)
Telephone Number ### - ### - ####
Email Address
Application Summary
Purpose
Amount Requested from the Tannenbaum-Sternberger Foundation
Total Project Budget
Prior Grants from the Tannenbaum-Sternberger Foundation
(Year / Amount / Purpose)
Brief History, Goals and Current Programs of Applicant
What is the Applicant Organization Deeply Passionate About? (25 words or less)
Summary of Most Recent Annual Financial Statement
Assets
... as of MM / DD / YYYY
Endowment
... as of MM / DD / YYYY
Fund Balance
... as of MM / DD / YYYY
The Need
Describe the need to which you are responding. (Please be factual and include any studies, demographic data or other facts that document the need)
The Project/Program
Describe the project/program and how it will respond to the need.
The Outcomes
What are the expected outcomes or results of the project/program?
The Evaluation
How will the outcomes or results be tested and proved?
The Cost

What will the project/program cost?
Project Budget from: MM / DD / YYYY
Project Budget to: MM / DD / YYYY
Expenses (by categories)
Income (by sources)
The Request
Amount Requested from the Tannenbaum-Sternberger Foundation
Funding Partners
List the names of other organizations, both public and private, to which you have applied for support of this project/program, the amount of the request and status (pending, granted or denied).
What percentage of the noprofit applicant’s staff and board members (state seperately) made a cash contribution to the applicant during the last 12 months?
Staff
Directors
Sustainability
What are the post-grant plans for sustaining the project/program?
Is the applicant controlled by, related to, connected with, or sponsored by another organization?
Yes No
If yes, identify the organization (including its purpose and activities) and explain the relationship:
List and describe similar projects by other groups in the same community and how these efforts are being coordinated with the applicant's project/program.
Attachments

The following items must be included with your grant application. Please mail a hard copy of any documents that you are unable to send as file attachments to this form.
1. A copy of your most recent IRS Determination Letter indicating current 501(c)(3) status and a letter signed by a responsible officer certifying that the determination letter remains in full force and effect.
2. A copy of the organization's financial statements for its most recent completed fiscal year.
3. A copy of the organization's budget for the current fiscal year and a statement of year-to-date revenues and expenses.
4. A list of the names and addresses of the members of your Board of Directors.
From my own knowledge, i state that the information given is correct. The applicant has authorized me to make this application.
Date MM / DD / YYYY
Name First Last
Title and Office
Do Not Fill This Out

Wufoo

Tannenbaum-Sternberger Foundation

Information About The Applicant

Application Summary

Summary of Most Recent Annual Financial Statement

The Need

The Project/Program

The Outcomes

The Evaluation

The Cost

The Request

Funding Partners

Sustainability

Attachments